PURPOSE: To compare the Doppler velocity waveform pattern of ophthalmic artery of hypertensive patients with that of normotensive subjects. MATERIALS AND METHODS: Doppler velocity waveform was obtained from ophthalmic artery in 45 hypertensive patients and 60 normotensive subjects. Both hypertensives and normotensive subjects were classified according to age into those younger than and those older than 45 years. Doppler indices[pulsatility index(PI), resistance index(RI), the first systolic peak/the second systolic peak(S1/S2), the first sytolic peak/diastolic peak (S1/D)] measured in hypertensive patients were compared with normotensive subjects. RESULTS: Among the various doppler indices, only S1/S2 showed significant difference(p < 0.05) between the hypertensive patients and normotensive subjects younger than 45 years. Doppler velocity waveform of hypertensive patients older than 45 years showed no significant difference from that of normotensive subjects with corresponding age. CONCLUSION: Doppler velocity waveform of ophthalmic artery in hyopertensive patients younger than 45 years shows pattern with S2 higher than that of normotensive subjects. High S2 component(reflective-wave) may represent increased vascular impedance ~ue to vasococonstriction of retinal arterioles in hypertensve patients.
Arterioles ; Electric Impedance ; Humans ; Ophthalmic Artery ; Retinaldehyde ; Ultrasonography*

Callus is a nonpenetrating circumscribed hyperkeratosis produced by repeated friction or pressure. It occurs on parts subjected to intermittent pressure, particularly on the palms and soles, and particularly over the bony prominences of the joints. In painful callosities of the feet, ill-fitting shoes and orthopedic problems of the foot (bunions, exostoses) are some of the etiological factors to be considered. Gout is a condition of inborn metabolic and/or acquired form of the disease characterized by hyperuricemia, tophaceous deposits of sodium urate and recurrent attacks of arthritis. We present a case of callus caused by tophi. The patient was a 45-year-old man who had complained of a painful, well-demarcated, hyperkeratotic plaque on the heel of the left foot for 18 months. After the tophi beneath overlying whitish thickened skin had been removed, the skin lesion disappeared and to date has not recurred.
Arthritis ; Bony Callus* ; Callosities ; Foot ; Friction ; Gout ; Heel ; Humans ; Hyperuricemia ; Joints ; Middle Aged ; Orthopedics ; Shoes ; Skin ; Uric Acid

Darier disease is a rare genodermatosis clinically characterized by multiple hyperkeratotic papules and plaques predominantly on seborrheic areas. It has characteristic histopathological features; corps-ronds, grains, suprabasal clefts or lacunae, villi projections etc. We present a case of Darier disease in a 36-year-old woman. She had suffered from skin lesions which bore a great resemblance to those of verruca plana or eruptive syringoma. We could confirm the diagnosis as Darier disease because she had the characteristic nail changes.
Adult ; Edible Grain ; Darier Disease* ; Diagnosis ; Female ; Humans ; Skin ; Syringoma ; Warts

Basaloid follicular hamartoma(BFH) is a rare, benign adnexal tumor with a wide clinical appearance spectrum. A characteristic finding is multifocal islands in the papillary dermis and branching cords of basaloid epithelial cells in continuity at various sites with the basal layer of the epidermis and the hair follicles. We present a case of basaloid follicular hamartoma combined with basal cell epithelioma that developed on the tip of the nose in a 75-year-old man. To our knowledge, this is the first case report of basaloid follicular hamartoma combined with basal cell epithelioma in the Korean literature.
Aged ; Carcinoma, Basal Cell* ; Dermis ; Epidermis ; Epithelial Cells ; Hair Follicle ; Hamartoma* ; Humans ; Islands ; Nose

This study was performed to evaluate the method of quantification of exercise thallium-201(201Tl) myocardial perfusion imaginges(M.P.I.) for the detection of coronary artery disease. Exercise 201 Tl MPI were interpreted objectively, reproducibly, quantitatively and easily by a computer assisted technique-Circumferential profile method. Exercise 201Tl MPI and redistribution images were taken in 32 patients(9 cases of post infarction angina, 13 cases of angina pectoris, 8 cases of atypical chest pain, 1 case of arrhythmial and 1 case of caridac neurosis). The results obtained were as follows: 1) Exercise 201Tl MPI of 3 cases of angina pectoris demonstrated transient perfusion defect in 5 cases, persistent perfusion defect in 2 cases, transient and persistent perfusion defect in 1 cases and no perfusion defect in 5 cases. Exercise 201Tl MPI of 9 case of post-infarction angina revealed persistent perfusion defect in 7 cases and transient and persistent perfusion defect in 2 cases. 201Tl MPI of 8 cases of atypical chest pain showed transient perfusion defect in 1 case and no perfusion defect in 7 cases. There was no perfusion defect in 1 case of arrhythmia and another case of cardiac neurosis. 2) The location of persistent perfusion defects in several views of 201Tl MPI in 9 case of postinfarction angina were consistent with those of infarction area in the electrocardiogram. 3) While visual analysis interpreted three cases to have no perfusion defect and one case to have transient perfusion defect respectively, objective analysis revealed that one of them had transient perfusion defect, another of them had persistent perfusion defect and the other had transient and persistent perfusion defect. 201Tl MPI of three cases could be done easily by circumferential profile method, which were difficult to interprete by subjective visual analysis. The results indicate that Exercise 201Tl MPI interpreted by circumferential profile analysis would be an objective, quantitative and noninvasive method for the detection of ischemic change and location in coronary artery disease.
Angina Pectoris ; Arrhythmias, Cardiac ; Chest Pain ; Coronary Artery Disease ; Electrocardiography ; Infarction ; Myocardial Ischemia* ; Neurocirculatory Asthenia ; Perfusion

PURPOSE: To understand the normal endosonographic anatomy of the perianal spaces, and to evaluate the diagnostic efficacy and limitation of endorectal sonography(EUS), correlative study with MRI, cadaveric sectional image and cadaveric MRI were performed. MATERIALS AND METHODS: EUS images of the normal 6 perianal spaces (pelvirectal, ischiorectal, intersphincteric, subcutaneous, central, submucous space) which were bounded by internal and external anal sphincters, rectal wall and levator ani muscle were correlated with MRI in 10 normal persons, cadaveric sectional images and cadaveric MRI in 2 cadavers. RESULTS: Pelvirectal space located superior to levator ani muscle could be demonstrable only on anterior wall scan but could not be visualized on lateral or posterior wall scan on EUS. Five perianal spaces located inferior to levator ani muscle were well seen on anterior, lateral, and posterior wall EUS. MRI was superior to EUS in the evaluation of pelvirectal and ischiorectal spaces but equal or inferior to EUS in the evaluation of intersphincteric, subcutaneous, central and submucous spaces. CONCLUSION: EUS was valuable in the evaluation of perianal spaces inferior to levator ani muscle but was limited in the evaluation of perianal spaces superior to levator ani muscle.
Anal Canal ; Cadaver* ; Humans ; Magnetic Resonance Imaging*

PURPOSE: All procedures for the removal of retained intrahepatic stones were performed on inpatient basis. We evaluated the advantage of the procedures performed on inpatient basis compared with outpatient basis in terms of the success rate, causes of failure and the complication. MATERIALS AND METHODS: Percutaneous removal of retained intrahepatic stones was performed in 58 patients through a T-tube tract on inpatient basis from April 1990 to December 4992. Stones were exclusively intrahepatic in 28 patients, whereas 30 patients had combined stones in common bile duct. Preshaped catheters, baskets, and balloon catheters were used to remove the stones and dilate the strictures of the ducts. Extracorporeal shock wave lithotripsy and choledochoscopy with electrohydraulic lithotripsy were used to crush the impacted stones. RESULTS: The stones were completely removed in 34 (58.6%) of 58 patients and most of the stones were removed in 17 patients (29.3%). The overall success rate was 87.9%. The complications (cholangitis in 13% and pancreatitis in 0.8% per session) were found and successfully managed by appropriate care. CONCLUSION: Better success rate could be achieved by more aggressive appraoch on inpatient basis when compared with previous reports on outpatient basis. We suggest that the procedures should be performed on inpatient basis especially in a case with severe strictures or impacted stones.
Catheters ; Common Bile Duct ; Constriction, Pathologic ; Humans ; Inpatients ; Lithotripsy ; Outpatients ; Pancreatitis ; Shock

No abstract available.
Adenocarcinoma* ; Carcinoma, Squamous Cell*

This study was done to investigate the effect volume overloading of right ventricle(RV) on the left ventricular(LV) volume and function in patients with isolated secundum type atrial septal defect(ASD) and to determine the hemodynamic indices affecting the postoperative reduction of RV size. Pre and postoperative echocardiogram and equilibrium radionuclide cardiac angiogram were analyzed in 39 patients of isolated secundum type ASD, who had their diagnosis confirmed by right heart catheterization and were operated at Seoul National University Hospital from January 1982 to July 1984. The ratio fo RV end-diastolic dimension to LV end-diastolic dimension(RVED/LVED), ratio of LV pre-ejection period and LV ejection time(PEP/LVET), ejection fraction(E.F.), fractional shortening(F.S.) mean velocity of circumferential fiber shortening(mVcf), peak ejection rate(PER) and peak filling rate(PFR) were measured in 24 normal control subjects and 39 patients with ASD before and after operation. The results obtained were as follows : 1) The postop. reduction of RV size could be correlated with age at operation, but showed no correlation with the degree of QP/Qs, main pulmonary arterial systolic, diastolic, mean pressure, RVEDP and previous RV size. 2) The ratio of postop. RVED/LVED(0.58+/-0.15) was significantly decreased, compared with the ratio of preop(0.96+/-0.28)(P<0.005)(Mean+/-1 S.D.). In preop and postop. status of ASD, the ratio of RVED/LVED was significantly larger than that of normal control subject(0.30+/-0.09)(P<0.005). 3) The ratio of preop PEP/LVET(0.33+/-0.02) was significantly decreased, compared with ratio of preop PEP/LVET(0.39+/-0.04)(P<0.005). There was significant difference between the ratio of preop. PEP/LVET and ratio of normal control subjects(0.33+/-0.05)(P<0.005), but no significant difference between the ratio of postop. PEP/LVET and ratio of normal control subjects(P>0.1). 4) There was no significant difference in LV systolic contractile functional indices between ASD group and normal control subjects and between pre and postop. status of ASD patients : LVEF was 63.5+/-6.1(%) in preop., 63.0+/-5.7(%) in postop and 62.4+/-6.6(%) in normal control subjects. F.S. was 27.3+/-5.7(%) in preop., 28.2+/-3.1(%) in postop. and 28.7+/-4.5(%) in normal control subjects. mVcf was 0.81+/-0.11(Cire/sec) in preop., 0.80+/-0.10(Circ/sec) in postop. and 0.82+/-0.14(Circ/sec) in normal control subjects. PER was 2.82+/-0.61(EDV/sec) in preop., 2.84+/-0.56(EDV/sec) in postop. and 2.84+/-0.45(EDV/sec) in normal control subjects. 5) The postop. PFR 3.34+/-0.46(EDV/sec) was significantly increased, compared with preop. PFR 2.51+/-0.46(EDV/sec)(P<0.005). There was significant difference between preop. PFR and normal control PFR 3.29+/-0.66(EDV/sec)(P<0.005), but no significant difference between postop. PFR and normal control PFR(P>0.1). 6) The postop. RVEF(51.4+/-6.3%) was significantly decreased, compared with preop. RVEF(54.5+/-9.9%)(P<0.005). Pre and postop. RVEF of ASD patient were significantly lower than RVEF of normal control group(60.3+/-3.1%)(P<0.01, P<0.005). The results indicate that postop. reduction of RV size could be correlated with age at operation. The effect of RV volume overloading on LV could not change systolic contractile functional indices, but diastolic filling index. There is many evidences suggesting that RV filling influences LV diastolic function which are occured by means of left ward shift of the interventricular septum and indirectly by linkage of filling of the two ventricules by common enclosure in the pericardium(underfilled LV volume and decreased LV compliance). Mildly diminished overall LV performance as shown by systolic time intervals appears to be related to the volume overload of the RV and to the concomitantly diminished volume of LV rather than to any myocardial contractility. LV systolic time inverval was non-invasive and sensitive index in assessing overall LV performance independent to LV geometric configuration and abnormal motion of regional ventricular wall.
Cardiac Catheterization ; Cardiac Catheters ; Diagnosis ; Heart Septal Defects, Atrial* ; Heart Ventricles* ; Hemodynamics* ; Humans ; Seoul ; Systole ; Ventricular Function, Left*

Prosthetic valve endocarditis(PVE) is not infrequent and one of the serious complications of cardiac valve replacement despite advances in antimicrobial therapy, diagnostic techniquens and surgical procedures. Although the incidence of PVE may be declining, the absolute number of cases of this infection is increasing. In patients with a prosthetic valve, fever, a regurgitant heart murmur, peripheral manifestations of infective endocarditis and postitive blood cultures, the diagnosis of PVE is evident. We have reviewed our experience with 13 patients with PVE from October 1976 through August 1983. During this period valve replacements were performed in 686 patients, with an infection rate of 1.9%. PVE currently accounts for approximately 14% of the total number of cases of infective endocarditis seen at Seoul national University Hospital. PVE occurred more often after multiple valve replacement than after replacement of single valve alone. Blood cultures were positive in 69% cases of PVE. Systemic emboli could be seen in 54% of patients with PVE and overall mortality was about 23%.
Diagnosis ; Endocarditis* ; Fever ; Heart Murmurs ; Heart Valves ; Humans ; Incidence ; Mortality ; Seoul